JP7087496B2 - Tow clip for endoscope - Google Patents

Description

The present invention relates to a traction clip for an endoscope that is inserted into the body using an endoscope and used to pull a part of a tissue in the body.

In endoscopic submucosal dissection (ESD), the detached lesion continues when a part of the lesion is incised and detached in order to facilitate the excision of the lesion and improve the certainty. In some cases, the entire lesion is incised while the detached lesion is lifted by applying a traction force to the lesion in advance so as not to interfere with the incision. As an endoscope clip used for such a procedure, for example, a traction clip provided with a traction spring as described in Patent Document 1 is known.

The traction clip described in Patent Document 1 closes a pair of arm portions made of elastic bodies that open legs in a state where no external force acts by sliding a tightening ring fitted to the connecting portion of the base end portion thereof. It is configured to roughly include a ring slide type clip and a traction spring composed of a coil spring. One end of the traction spring is connected to a clip via a ring-shaped member, and a loop member made of a loop-shaped string for gripping with another clip is attached to the other end of the traction spring.

When excising the lesion, the peeled part of the lesion is grasped with a traction clip, and the loop member is scooped up between a pair of arms of another ring slide type clip prepared separately. While elastically deforming (stretching) the traction spring, the other clip grips a portion of the mucosa (eg, the mucosa facing the lesion). As a result, the traction force acts on the lesion due to the elasticity of the traction spring, so that the lesion peeled off by the incision is lifted. Therefore, since the surgical field can be secured without obstructing the field of view by the detached lesion, the entire circumference of the lesion can be easily and surely incised.

By the way, as described above, after grasping a part of the mucous membrane with another ring slide type clip and applying a traction force, the operator pulls the traction because the direction of the traction is not appropriate or more appropriate. There may be times when you want to change direction. However, although the ring slide type clip is not impossible to replace (clip release and re-clip) due to its structure, it is necessary to perform complicated work using a dedicated instrument. Therefore, it was necessary to remove the traction clip once and then restart the traction procedure from the beginning using a new traction clip, and it was not easy to change the direction of traction.

When the series of procedures is completed, the loop member is cut using a cutting instrument such as a scissors forceps for an endoscope, which is also called a loop cutter, or an electric knife for an endoscope, and the lesion is grasped. The tow clip is collected. However, it is not preferable to separately prepare a cutting instrument used only for cutting a loop member such as a pair of scissors forceps for an endoscope because it is complicated and the cost required for the treatment increases. Further, cutting the loop member with an electric knife for an endoscope is not preferable because it may unexpectedly damage internal tissues in the vicinity of the loop member.

JP-A-2015-192726

The present invention has been made in view of such a point, and an object of the present invention is to provide a traction clip for an endoscope which can easily change the direction of traction and can be recovered without using a cutting instrument. ..

The traction clip for an endoscope according to the present invention
The first arm portion is fitted to a pair of first arm portions arranged with the tip side opened in a state where no external force acts, and a connecting portion on the base end side of the first arm portion, and is slid to the tip side. A ring slide clip with a tightening ring that closes the arm,
It is provided between a pair of second arm portions and the second arm portion, and when no external force acts, the tip end side of the second arm portion closes close to each other, and the rear end side of the second arm portion comes close to each other. A pinch-type clip provided with an urging spring portion that urges the tip side of the second arm portion to separate and open the legs by pressing the second arm portion.
It has a traction spring, one end of which is connected to the ring slide type clip and the other end of which is connected to the pinch type clip.

The traction clip for an endoscope according to the present invention is a pinch type clip in which the tip side is opened by pressing the rear end side of the second arm portion so as to be close to each other, and the tip side is closed by releasing the pressing. have. Therefore, for example, after grasping the lesion or the like with a ring slide type clip and stretching a traction spring while grasping a part of the mucous membrane or the like with a pinch type clip and applying a traction force, the operator moves the direction of traction. If you want to change the direction of traction because it is not appropriate, press the rear end side of the second arm part so that they are close to each other to release the grip of the mucous membrane by the pinch type clip, and then another position different from the position. It is possible to release the pressure at the position and grip it again. Since the clips can be easily replaced in this way, the direction of traction can be easily changed.

Further, for example, after excising the lesion portion gripped by the ring slide type clip, if the rear end side of the second arm portion is pressed so as to be close to each other to release the gripping of the mucous membrane by the pinch type clip, the traction clip is obtained. Can be recovered together with the lesion, and it is not necessary to cut the loop member with a cutting instrument such as a pair of scissors forceps for an endoscope or an electric knife for an endoscope as in the prior art. Therefore, it is not necessary to separately prepare such a cutting tool, and the cost can be reduced.

In the traction clip for an endoscope according to the present invention, each of the rear end portions of the second arm portion can be provided with recesses that are recessed on the sides facing each other. When the rear end side of the second arm portion of the pinch type clip is pressed so as to be close to each other by using a clip device or the like described later, the recessed portion is pressed so that the gripping position is displaced by the clip device. Slip can be suppressed and the work for releasing clipping can be facilitated.

FIG. 1A is a diagram showing an overall configuration of a traction clip for an endoscope according to an embodiment of the present invention. FIG. 1B is a diagram showing the orientation of each part constituting the tow clip of FIG. 1A by appropriately changing the direction. FIG. 2 is a diagram showing a coil spring of the tow clip of FIG. 1A. FIG. 3A is a perspective view of a pinch-type clip of the tow clip of FIG. 1A. FIG. 3B is a side view showing the open leg state of the pinch type clip of FIG. 3A. FIG. 4A is a diagram showing the appearance of the clip device. FIG. 4B is a cross-sectional view taken along the line IVb-IVb of FIG. 4A. FIG. 4C is a perspective view showing the configuration of the opening / closing hook of the clip device of FIG. 4A and its vicinity. FIG. 5A is a diagram showing a state in which the tow clip of FIG. 1A is connected to the tip of the clip device. FIG. 5B is a diagram showing a state in which the tow clip of FIG. 1A is housed in the tip of the clip device. FIG. 6A is a diagram schematically showing a state in which a part of the lesion is incised using the traction clip of FIG. 1A. FIG. 6B is a diagram schematically showing a state in which the gripping position of the pinch-type clip is changed in order to change the direction of traction during the incision of the lesion portion following that of FIG. 6A. FIG. 6C is a diagram schematically showing a state in which the incision of the lesion portion following that of FIG. 6B is completed.

Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings. As shown in FIGS. 1A and 1B, the endoscope traction clip 1 according to the present embodiment is configured to substantially include a ring slide type clip 2, a coil spring (traction spring) 3, and a pinch type clip 4. ing.

The ring slide type clip 2 includes a connecting plate portion (connecting portion) 21, a pair of arm plate portions (first arm portion) 22, and a tightening ring 24. The connecting plate portion 21 has a shape bent into a substantially U-shape, and the tip side is opened in a substantially V-shape in a state where external force does not act continuously on each end of the U-shape. The pair of arm plate portions 22 are integrally formed.

The tightening ring 24 is a ring-shaped member that is slidably fitted to the connecting plate portion 21 on the base end side of the arm plate portion 22. The tightening ring 24 is a clip device 5 (see FIGS. 4A to 4C, details) having an opening / closing hook 51 that is freely arranged with respect to the inner sheath 52 and the inner sheath 52 and is detachably connected to the connecting plate portion 21. It is a member that is slid using (described later). The tightening ring 24 is pushed and slid by the tip of the inner sheath 52 by pulling the opening / closing hook 51 from the tip of the inner sheath 52 in a state where the opening / closing hook 51 is connected to the connecting plate 21, and the arm The plate portion 22 is closed.

A claw portion 23 is integrally formed at the tip portion of each arm plate portion 22. The claw portion 23 is formed by being bent toward the inside (that is, the closing direction) at the tip of the arm plate portion 22. Each claw portion 23 has a notch (not shown) recessed in the middle portion of the tip thereof.

The connecting plate portion 21 constituting the ring slide type clip 2, the pair of arm plate portions 22, and the pair of claw portions 23 are formed by bending and molding one thin and elongated plate material. The plate thickness of the plate material constituting the ring slide type clip 2 is not particularly limited, but is preferably 0.10 to 0.30 mm. As the plate material, an elastic metal plate material is preferable, and for example, a stainless steel plate is used.

As shown in FIG. 1B, the arm plate portion 22 has a base end portion 22a and a grip portion 22b, respectively. Penetration portions 22c are formed in the grip portions 22b of each arm plate portion 22. These penetrating portions 22c are formed without impairing the desired strength of the arm plate portion 22 (grip portion 22b). These through holes 22c are formed from the viewpoint of adjusting the elasticity (repulsive force) when the arm plate portion 22 is closed by the tightening ring 24. One of these penetrating portions 22c is also used to connect the coil spring 3 to the ring slide type clip 2, which will be described in detail later.

A tightening ring 24 is slidably fitted in the connecting plate portion 21. The tightening ring 24 is composed of a substantially cylindrical ring member. However, the tightening ring 24 may be composed of a spring formed by winding a wire rod in a coil shape. The connecting plate portion 21 is inserted into the guide hole inside the tightening ring 24, and the tightening ring 24 can move (slide) in the axial direction between the outer circumference of the connecting plate portion 21 and the outer circumference of the base end portion 22a of the arm plate portion 22. It is attached (outer fitting) to. As the material of the tightening ring 24, metal is preferable, and for example, stainless steel is used.

When the tightening ring 24 is arranged closer to the rear (connecting plate portion 21) as shown in FIGS. 1A or 1B, the arm plate portion 22 is opened (opened) by its own elasticity. By moving (sliding) the tightening ring 24 to a position closer to the tip (base end portion 22a) as necessary, the arm plate portion 22 can be closed (closed legs). ..

The coil spring 3 is a tension coil spring formed by winding a metal wire such as stainless steel. As shown in FIG. 2, the coil spring 3 has a hook portion 32 for connecting to the ring slide type clip 2 at one end of the main body portion 31 formed by winding a metal wire, and the other end of the main body portion 31. Has a hook portion 33 for connecting to the pinch type clip 4. The hook portions 32 and 33 have a portion corresponding to approximately one round (which may be one or more) of one end of a metal wire (main body 31) wound in a substantially cylindrical shape. It is formed by bending it at approximately 90 degrees with respect to a plane orthogonal to the axis of. The hook portions 32 and 33 may be separately manufactured and fixed to both ends of the wound metal wire by welding.

As shown in FIGS. 3A and 3B, the pinch type clip 4 is a clip attached to a part of the ring slide type clip 2 via the coil spring 3. The pinch type clip 4 substantially includes a pair of arm plates (second arm portion) 41 and an urging spring (urging spring portion) 42.

The pair of arm plates 41 have symmetrical shapes, and are arranged so as to have a substantially V shape so that the tip sides are close to each other, and the pair of arm plates 41 are provided between the pair of arm plates 41. It is supported and fixed to one end side and the other end side of the spring 42. When no external force acts on the urging spring 42, the urging force of the urging spring 42 keeps the pair of arm plates 41 in a closed state.

The urging spring 42 is a torsion coil spring, and both ends of the coil are mounting portions 42a formed in a substantially linear shape, and the mounting portions 42a correspond to the inner surfaces (faces facing each other) of the arm plate 41. It is fixed by laser welding or the like. In the present embodiment, the urging spring 42 supports the pair of arm plates 41 in addition to urging them. However, a support portion is provided on a part of the pair of arm plates 41. The support portion of one arm plate 41 may be rotatably supported by the support portion of the other arm plate 41, and the urging spring 42 may perform only these urging. As the urging spring, a torsion coil spring is used here, but for example, a leaf spring formed in a substantially U shape may be used.

By pressing the rear end sides of the pair of arm plates 41 against the urging force of the urging spring 42 so as to be close to each other, the front end sides of the pair of arm plates 41 are separated from each other and the legs are opened. When the pressing is released, the urging force of the urging spring 42 can return the pair of arm plates 41 to their original closed legs in close proximity to each other.

Through holes 41d penetrating both sides are formed in the rear end portions 41b of the pair of arm plates 41. One of these through holes 41d is a hole used for connecting the coil spring 3 to the pinch type clip 4 by passing the hook portion 33 of the coil spring 3 through the hole. For this purpose, the through hole 41d may be provided only on one of the pair of arm plates 41, but it is advantageous in manufacturing that the pair of arm plates 41 have the same configuration as each other. Since it may be used when gripping with the opening / closing hook 51 of the clip device 5 described later, it is better to provide both.

On the rear end side of the pair of arm plates 41 and on the tip side of the through hole 41d, recesses 41c that are smoothly recessed in a substantially arc shape are formed on the opposite sides (inside) of the pair of arm plates 41. Has been done. The recess 41c is formed so as to extend from one side of the arm plate 41 in the lateral direction to the other side.

When the recess 41c is gripped by the opening / closing hook 51 of the clip device 5 described later, the opening / closing hook 51 is accessed from the side of the pinch type clip 4, and the arm portion of the opening / closing hook 51 is accessed in the longitudinal direction of the arm plate 41. It is provided to suppress the displacement and slippage of the opening / closing hook 51 and improve the certainty of gripping when gripping in a state where the hooks are arranged so as to intersect with each other.

A claw portion 41a is integrally formed at the tip end portion of each arm plate 41. The claw portion 41a is formed by being bent toward the inside (that is, the closing direction) at the tip of the arm plate 41. Each claw portion 41a is not particularly limited, but may have a notch portion that is recessed in a substantially V shape, for example, in the intermediate portion of the tip thereof.

The arm plate 41 is formed by bending or press-forming a thin and elongated plate material. The plate thickness of the plate material constituting the arm plate 41 is not particularly limited, but is preferably 0.10 to 0.30 mm. As the plate material, for example, a stainless steel plate is used.

The endoscope traction clip 1 as described above is attached to and stored in the tip end (distal end portion) of the clip device 5 as shown in FIGS. 4A and 4B, and the sheath of the clip device 5 is attached. The portions (inner sheath 52 and outer sheath 54) are inserted into the treatment tool guide tube of the endoscope and guided to the mucous membrane (living tissue) to be treated.

As shown in FIG. 4A or FIG. 4B, the clip device 5 includes an opening / closing hook 51, an inner sheath 52, a drive wire 53, an outer sheath 54, a reinforcing coil 55, an outer sheath operating portion 56, and an inner sheath operating portion 57. And the wire operation unit 58 are roughly provided.

A tubular inner sheath 52 is also inserted through the tubular outer sheath 54, and a drive wire 53 is inserted through the inner sheath 52. The inner sheath 52 is slidable (sliding) in the outer sheath 54, and the drive wire 53 is slidable (sliding) in the inner sheath 52.

The outer sheath 54 is made of a flexible hollow tube, and a coil tube is used in this embodiment. As the coil tube, a flat wire coil tube formed by spirally winding a long flat plate made of metal (stainless steel) or the like can be used. However, a round wire coil tube or an inner flat coil tube may be used. The inner diameter of the outer sheath 54 is about 2.0 to 3.0 mm.

The inner sheath 52 is made of a flexible hollow tube, and a wire tube is used in this embodiment. The wire tube is a tube made of hollow stranded wires obtained by spirally twisting a plurality of wires (cables) made of, for example, metal (stainless steel) so as to be hollow. As the inner sheath 52, a wire tube may be mainly used, and a coil tube may be used only on a part of the tip side thereof. The inner diameter of the inner sheath 52 is about 1.5 to 2.5 mm.

The drive wire 53 is made of a flexible wire, and a wire rope is used in this embodiment. The wire rope is a rope made of stranded wires obtained by twisting a plurality of wires (cables) made of, for example, metal (stainless steel) in a spiral shape. However, as the drive wire 53, the same wire tube as the inner sheath 52 may be used.

As shown in FIG. 4C, the opening / closing hook 51 arranged at the tip of the sheath of the clip device 5 has a pair of arm portions 51a, 51a made of elastic bodies arranged in a substantially V shape toward the tip thereof. In cooperation with the inner sheath 52, it is possible to take two states, an open leg (open) state and a closed leg (closed) state. Claws 51b and 51b are formed at the tips of the arm portions 51a and 51a of the opening / closing hook 51 by being bent inward (opposite to each other) to grip the connecting portion 21 of the ring slide type clip 2. Can be connected.

The base end portion of the opening / closing hook 51 is a U-shaped portion 51c formed continuously in a substantially U-shape on the base end portions of the pair of arm portions 51a and 51a. The arm portions 51a, 51a and the U-shaped portion 51c including the claw portions 51b, 51b can be formed by appropriately bending (plastically deforming) one elongated plate material made of an elastic body. Although not particularly limited, the plate material constituting the opening / closing hook 51 has a plate thickness of about 0.20 to 0.24 mm and a width of about 0.6 mm. As the plate material, for example, stainless steel is used.

An annular member 53a formed in a substantially annular shape is integrally welded and fixed to the tip (distal end) of the drive wire 53 slidably inserted into the inner sheath 52 by laser welding or the like. The outer diameter of the annular member 53a is about 1.2 mm, and the inner diameter is about 0.8 to 1.0 mm.

The opening / closing hook 51 is inserted through the annular member 53a, and the U-shaped portion 51c is arranged so as to be loosely fitted to the annular member 53a, so that the opening / closing hook 51 can be swingably attached to the distal end of the drive wire 53. .. By attaching the opening / closing hook 51 to the tip of the drive wire 53 via such an annular member 53a and the U-shaped portion 51c loosely fitted to the annular member 53a, the opening / closing hook 51 is referred to as an arrow in FIG. 4C. It can rotate freely in the a1 direction.

Returning to FIGS. 4A and 4B, the vicinity of the base end (proximal end) side of the outer sheath 54 is inserted into the reinforcing coil 55 and integrally fixed to the reinforcing coil 55. The reinforcing coil 55 is integrally fixed to the outer sheath operating portion 56, and a portion on the distal end side of the inner sheath operating portion 57 is inserted and arranged inside the outer sheath operating portion 56. The outer sheath operating portion 56 can be positioned with respect to the inner sheath operating portion 57 between a position moved to the distal end (distal end) side and two positions moved to the proximal end (proximal end) side. It is designed to be able to slide.

The wire operating portion 58 is slidably held in the inner sheath operating portion 57, and the inner sheath 52 is fixed to the inner sheath operating portion 57. The base end of the drive wire 53 is fixed to the wire operating portion 58.

When the wire operating portion 58 is slid toward the tip side (distal end side) with respect to the inner sheath operating portion 57, the inner sheath 52 is pulled with respect to the drive wire 53, and the opening / closing hook 51 at the tip of the drive wire 53 is opened. It protrudes from the tip of the inner sheath 52 and opens its legs by its own elasticity. When the wire operating portion 58 is slid toward the proximal end side (proximal end side) with respect to the inner sheath operating portion 57, the drive wire 53 is pulled with respect to the inner sheath 52, and the opening / closing hook 51 at the tip of the drive wire 53 is pulled. Is gradually closed while entering the inner sheath 52, and is buried in the inner sheath 52 so that the legs are completely closed.

When the outer sheath operating portion 56 is slid to a position on the base end side with respect to the inner sheath operating portion 57, the inner sheath 52 can be projected from the tip of the outer sheath 54, and conversely, the outer sheath operating portion 56 is moved to the inner sheath. When the tip of the inner sheath 52 is slid to the position on the tip side with respect to the operation portion 57, the tip of the inner sheath 52 can be stored (buried) in the outer sheath 54.

Next, the method of using the above-mentioned traction clip 1 for an endoscope will be described with reference to FIGS. 5A, 5B, and 6A to 6C.

In the ring slide type clip 2 of the traction clip 1 for an endoscope, when the tightening ring 24 is externally fitted near the base end portion 22a on the outer periphery of the connecting plate portion 21, the connecting plate portion 21 having a U-shaped cross section is fitted. Is formed with a connecting hole 25 (see FIGS. 1A and 5A). By engaging the opening / closing hook 51 of the clip device 5 shown in FIG. 4A with the connecting hole 25 and pulling the opening / closing hook 51 into the inner sheath 52, the opening / closing hook 51 is closed and the ring slide type clip 2 is inner. It is attached to the tip of the sheath 52 (see FIG. 5A).

In this state, the tip of the inner sheath 52 to which the endoscope traction clip 1 (ring slide type clip 2, coil spring 3 and pinch type clip 4) is connected is pulled into the outer sheath 54 and is shown in FIG. 5B. As such, the entire endoscope traction clip 1 (ring slide type clip 2, coil spring 3 and pinch type clip 4) is housed inside the distal end portion of the outer sheath 54.

In this state, the tightening ring 24 of the ring slide type clip 2 remains located at the connecting plate portion 21, and the arm plate portion 22 is closed by the action of the inner wall of the outer sheath 54. Further, the pinch type clip 4 is housed in the outer sheath 54 in a state where the pair of arm plates 41 are substantially parallel to each other against the urging force of the urging spring 42 by the action of the inner wall of the outer sheath 54. .. When the pinch type clip 4 is housed in the outer sheath 54, the rear end sides of the arm plates 41 are pressed so as to be close to each other so that the pair of arm plates 41 are substantially parallel to each other. It is good to pull it into 54.

The tip of the sheath portion of the clip device 5 to which the traction clip 1 for an endoscope is attached is inserted through a treatment tool guide tube of an endoscope (not shown) inserted into the body to perform excision (peeling) treatment. Place it near the mucosa to be done. Then, by sliding the outer sheath 54 toward the proximal end side, the endoscopic traction clip 1 is projected from the distal end of the outer sheath 54. As a result, as shown in FIG. 5A, the arm plate portion 22 is in a state of being opened by its own elasticity, and the pair of arm plates 41 of the pinch type clip 4 are closed to the urging spring 42 by the urging force. It will be in the state of.

Next, refer to FIG. 6A. With the pair of arm plate portions 22 of the ring slide type clip 2 open, the ring so that the site (lesion portion) X to be excised (peeled) of the mucous membrane exists between the pair of arm plate portions 22. Position the slide clip 2. Next, by sliding the inner sheath 52 toward the tip end side with respect to the drive wire 53, the tightening ring 24 slides toward the tip end side of the arm plate portion 22. As a result, the arm plate portion 22 gradually closes (approaches each other), and the mucous membrane on one side and the mucous membrane on the other side are pulled together with the lesion portion X in between.

By further sliding the inner sheath 52 toward the tip side with respect to the drive wire 53, the tightening ring 24 moves to the grip portion 22b side of the arm plate portion 22, and the grip of the lesion portion X by the ring slide type clip 2 is completed. .. In this state, by sliding the inner sheath 52 toward the base end side with respect to the drive wire 53, the opening / closing hook 51 is pushed out from the distal end of the inner sheath 52 to open the legs, and the opening / closing hook of the ring slide type clip 2 is opened. The grip (engagement) by 51 is released, and clipping of the ring slide type clip 2 to the lesion X is completed.

Next, the pinch type clip 4 is clipped using the clip device 5 from which the tow clip 1 (ring slide type clip 2) is separated. First, the opening / closing hook 51 is projected from the tip of the inner sheath 52 of the clip device 5 to open the opening / closing hook 51. In this state, one of the pair of arm portions 51a of the opening / closing hook 51 is arranged along one of the recesses 41c of the pair of arm plates 41 of the pinch type clip 4 in the body, and the pair of arm plates of the pinch type clip 4 are arranged. The position and posture of the opening / closing hook 51 are appropriately adjusted so that the other of the pair of arm portions 51a of the opening / closing hook 51 is arranged along the other of the recess 41c of the 41.

With the pinch-type clip 4 arranged as described above between the pair of arm portions 51a of the opening / closing hook 51 of the clip device 5, the inner sheath 52 is pushed out with respect to the drive wire 53 to open / close the hook 51. By closing the legs, the rear end sides (the portion of the recess 41c) of the pair of arm plates 41 of the pinch type clip 4 are pressed so as to be close to each other. As a result, the pinch type clip 4 is gripped by the opening / closing hook 51 in a state where the pair of arm plates 41 of the pinch type clip 4 are opened.

Next, the tip of the sheath portion of the clip device 5 that grips the pinch-type clip 4 is conveyed to the vicinity of an appropriate portion (opposing portion) Y facing (opposing) the lesion portion X, and the coil spring 3 is stretched while being pinched. The position is set so that the facing portion Y can be sandwiched between the pair of arm plates 41 of the mold clip 4. After that, when the inner sheath 52 is pulled back to the drive wire 53 to open the opening / closing hook 51, the pressure on the pinch type clip 4 is released, so that the pair of arm plates 41 of the pinch type clip 4 are urged springs. The leg is closed by the urging force of 42, and the pinch type clip 4 is clipped with respect to the facing portion Y. As a result, the lesion X is pulled (lifted) by the elastic force (tension) of the coil spring 3.

After making this state, an electric scalpel for endoscopy 7 is inserted through the treatment tool guide tube of the endoscope, and the outer periphery of the lesion portion X is incised using the electric scalpel 7. Since the lesion X is lifted from the part peeled by the incision by the elastic force (tension) of the coil spring 3, the part peeled by the incision of the lesion X is less likely to obstruct the view or interfere with the procedure. Therefore, the entire circumference of the lesion X can be easily and surely incised.

If the surgeon wishes to change the pulling direction of the lesion X, for example, during the incision of the lesion X or before starting the incision, the opening / closing hook 51 from the tip of the inner sheath 52 of the clip device 5 Is in a state where the opening / closing hook 51 is opened. In this state, the recesses 41c on the rear end side of the pair of arm plates 41 of the pinch type clips 4 holding the facing portion Y are arranged so as to be sandwiched by the opening / closing hook 51 in the same manner as described above. Next, the inner sheath 52 is pushed out with respect to the drive wire 53 to close the opening / closing hook 51 so that the rear end sides (the portion of the recess 41c) of the pair of arm plates 41 of the pinch type clip 4 are close to each other. By pressing, the pair of arm plates 41 of the pinch-type clip 4 are opened, and the pinch-type clip 4 is gripped in a state where clipping to the facing portion Y is released.

Next, refer to FIG. 6B. After releasing the clipping of the pinch-type clip 4 to the facing portion Y, the tip of the sheath portion of the clip device 5 that grips the pinch-type clip 4 is placed on the desired portion (changed portion) Z whose position is different from that of the facing portion Y. It is transported to the vicinity, and while the coil spring 3 is stretched, it is set at a position where the changed portion Z can be sandwiched by the pair of arm plates 41 of the pinch type clip 4. After that, when the inner sheath 52 is pulled back to the drive wire 53 to open the opening / closing hook 51, the pressure on the pinch type clip 4 is released, so that the pair of arm plates 41 of the pinch type clip 4 are urged springs. The leg is closed by the urging force of 42, and the pinch type clip 4 is clipped with respect to the changed portion Z. As a result, the towing direction is changed. When the extension amount of the coil spring 3 is also changed, the traction force is also changed.

After changing the direction of traction, if the incision of the lesion X has been performed halfway, the remaining incision is performed, or if the incision has not started yet, the entire circumference of the lesion X is incised. When the incision of the lesion portion X is completed, as shown in FIG. 6C, the opening / closing hook 51 is projected from the tip of the inner sheath 52 of the clip device 5 to open the opening / closing hook 51.

In this state, the recesses 41c on the rear end side of the pair of arm plates 41 of the pinch type clips 4 holding the changed portion Z are arranged so as to be sandwiched by the opening / closing hook 51 in the same manner as described above. Next, the inner sheath 52 is pushed out with respect to the drive wire 53 to close the opening / closing hook 51 so that the rear end sides (the portion of the recess 41c) of the pair of arm plates 41 of the pinch type clip 4 are close to each other. By pressing, the pair of arm plates 41 of the pinch type clip 4 are opened to release the clipping with respect to the changed portion Z, and the traction clip 1 gripping the lesion portion X is collected. This completes a series of procedures.

The endoscope traction clip 1 of the above-described embodiment is configured by connecting a pinch type clip 4 to the other end of a coil spring 3 to which a ring slide type clip 2 is connected to one end thereof. Since the pinch type clip 4 can be opened and closed by pressing or releasing the rear end sides of the pair of arm plates 41 so as to be close to each other, it is possible to relatively easily replace the pinch type clip 4 with respect to the mucous membrane or the like. Therefore, the traction direction and the traction force can be easily changed.

Further, after excision of the lesion portion X gripped by the ring slide type clip 2, the gripping of the mucous membrane can be released only by pressing the rear end sides of the pair of arm plates 41 of the pinch type clip 4 so as to be close to each other. Therefore, the traction clip 1 can be recovered together with the lesion X, and it is necessary to cut the loop member with a cutting instrument such as a pair of scissors forceps for an endoscope or an electric knife for an endoscope as in the prior art. do not have. Therefore, it is not necessary to separately prepare a cutting instrument used only for cutting the loop member such as the scissors forceps for the endoscope, and the cost can be reduced. In addition, it is possible to avoid the use of cutting instruments such as electric scalpels for endoscopes, which may unexpectedly damage internal tissues.

Further, as described above, the pinch type clip 4 can open and close the pair of arm plates 41 by using the clip device 5 used for clipping the ring slide type clip 1. Therefore, the delivery (transportation) of the traction clip 1 for the endoscope into the body, the clipping by the ring slide type clip 2, the clipping by the pinch type clip 4, and the release thereof are performed by using a single clip device 5. It can be carried out. Moreover, it is also possible to perform these series of procedures with the clip device 5 inserted in the body without pulling it out. Therefore, it is possible to simplify a series of procedures and reduce the cost, which is convenient.

The embodiments described above are described for facilitating the understanding of the present invention, and are not described for limiting the present invention. Therefore, each element disclosed in the above-described embodiment is intended to include all design changes and equivalents belonging to the technical scope of the present invention.

1 ... Endoscope traction clip 2 ... Ring slide type clip 21 ... Connecting plate (connecting part)
22 ... Arm plate (first arm)
22a ... Base end 22b ... Grip 23 ... Claw 24 ... Tightening ring 25 ... Connecting hole 3 ... Coil spring (traction spring)
31 ... Main body 32, 33 ... Hook 4 ... Pinch type clip 41 ... Arm plate (second arm)
41a ... Claw portion 41b ... Rear end portion 41c ... Recessed portion 41d ... Through hole 42 ... Biasing spring 5 ... Clip device 51 ... Opening / closing hook 52 ... Inner sheath 53 ... Drive wire 54 ... Outer sheath 7 ... Electric knife for endoscope X ... lesion Y ... opposite site Z ... changed site

Claims (2)

The first arm portion is fitted to a pair of first arm portions arranged with the tip side opened in a state where no external force acts, and a connecting portion on the base end side of the first arm portion, and is slid to the tip side. A ring slide clip with a tightening ring that closes the arm,
It is provided between a pair of second arm portions and the second arm portion, and when no external force acts, the tip end side of the second arm portion closes close to each other, and the rear end side of the second arm portion comes close to each other. A pinch-type clip provided with an urging spring portion that urges the tip side of the second arm portion to separate and open the legs by pressing the second arm portion.
It has a traction spring, one end of which is connected to the ring slide clip and the other end of which is connected to the pinch clip.
The second arm portion is provided with recesses that are recessed on the sides facing each other.
One of the second arm portions is provided with a through hole formed on the rear end side of one of the recesses of the second arm portion.
The traction spring has a hook portion at the other end thereof and has a hook portion.
The traction spring is an endoscope traction clip in which the hook portion is passed through the through hole of one of the second arm portions and connected to one of the second arm portions . The traction clip for an endoscope according to claim 1 , wherein the other side of the second arm portion has a through hole formed on the rear end side of the other recess of the second arm portion .

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